Legal and IT Coordination in a Complex Health System

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Legal and IT Coordination in a Complex Health
System

• Presentation to Information Security Compliance
  Risk Management Institute
• Wednesday September 16, 2009
• Laird A. Pisto, JDPaul VanAmerongen, CISSP

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MultiCare Health System
Integrated Delivery Network Cradle to Grave
All Points In Between
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EMR Risk Analysis
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(No Transcript)
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Recent Legal and Regulatory Change Requirements

• Federal Rules of Civil Procedure (FCRP)
  Electronic information disclosure
• Red Flags Identification and notification of
  identity theft
• American Recovery and Reinvestment Act of 2009
  (ARRA) - Changes to HIPAA
• Health Information Technology for Economic and
  Clinical Health Act (HITECH) - Expands on HIPAA

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ONCHIT GOALS 2008 - 2010

• Goal One Inform Clinical Practice
• Goal Two Interconnect Clinicians
• Goal Three Personalize Care
• Goal Four Improve Population Health
• Each of these is fully embedded in HITECH ACT

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Goals Mirror Risks
Patient Safety
Access
Accuracy
Efficiency
Financial Performance
100 Adoption
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Information Security Change Management
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Information Security Sir Isaac Newton
Newtons First Law of Motion Things tend to
keep doing what theyre doing.
Newtons Second Law of Motion Acceleration is
proportional to force.
Newtons Third Law of Motion For every action,
there is an equal and opposite reaction.
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Typical Data Sources For Discovery
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Clinical Systems
Business Systems
Health System
Health System
Subsidiary
Subsidiary
REVENUE CYCLE SYSTEMS
REVENUE CYCLE SYSTEMS
Epic Bed Management
Epic Patient Access/ Registration
Epic Enterprise Patient Scheduling
Meditech Patient Access/ Registration
Meditech Enterprise Patient Scheduling
Meditech Bed Management
HDX Insurance Eligibility
Epic Clinic Practice Management
Epic HIM
Provider Advantage Insurance Eligibility
Misys Clinical Practice Management
Meditech HIM
ePremis Claims Processing
Third Millenium Claims Digital Archive
nCoder Coding
ePremis Claims Processing
E-Cabinet Claims Digital Archive
3M Coding
Epic Patient Billing
Epic Patient Tracking
Meditech Patient Billing
ANCILLARY SYSTEMS
ANCILLARY SYSTEMS
FINANCIAL SYSTEMS
FINANCIAL SYSTEMS
Misys Lab
Epic Rx
HBS Outpatient Rx- Retail POS
Meditech Lab
Meditech Rx
NDC Outpatient Rx- Retail POS
Lawson Accounts Payable
Lawson General Ledger
McKesson Budgeting/ Financial Planning
Meditech Accounts Payable
Meditech General Ledger
Budget Advisor/ Financial Budgeting/ Financial
Planning
Pyxis Medication Distribution
ImageCast Radiology
Siemens Cardiology
GE Cardiology
MedSelect Medication Distribution
Lawson Payroll
Lawson Human Resources
Workbrain Time Attendance
Infinium Payroll
Infinium HR
Kronos Time Attendance
Epic Home Health/ Hospice
Stryker Surgery Center Systems
Computrition Nutrition Services
VST Nutrition Services
SurgiServ Surgery Center Systems
PTcT Home Health/ Hospice
Ascent Contract Management
Lawson Recruitment Management
TractManager Contracts Management
TractManager Contracts Management
Ascent Contract Management
E-Labor Recruitment Management
CoPath Pathology
GE NICU Fetal Monitoring
ORSOS Surgery Scheduling
Meditech OR
GE Labor Delivery
CoPath Pathology
McKesson Decision Support
Power Manager Decision Support
Lawson Materials Management
Meditech Materials Management
Meditech Reporting
HBI/HPM Management Reporting
Epic/ Varian
Hospira Smart Pumps
Provation GI Lab Documentation System
Hospira Smart Pumps
MISCELLANEOUS SYSTEMS
MISCELLANEOUS SYSTEMS
Oncology
Ansos Scheduling- Clinical
Various Scheduling- Non-Clinical
Ansos Scheduling- Clinical
Kronos Scheduling- Non-Clinical
Pyxis OR Surgical Supply Station
Hologic Digital Mammography
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Many Become One? Or Not?
Business Systems
Clinical Systems
Health System
Subsidiary
Health System
Subsidiary
REVENUE CYCLE SYSTEMS
REVENUE CYCLE SYSTEMS
CORE CLINICAL SYSTEMS
CORE CLINICAL SYSTEMS
eScription Transcription
eScription Transcription
Epic Orders/ Results
Epic Clinical Data Repository
Epic Bed Management
Epic Patient Access/ Registration
Epic Enterprise Patient Scheduling
Epic Bed Management
Epic Enterprise Patient Scheduling
Epic Patient Access/ Registration
Epic Orders/ Results
Epic Clinical Data Repository
HDX Insurance Eligibility
Epic Clinic Practice Management
Epic HIM
Epic Clinical Practice Management
Epic HIM
HDX Insurance Eligibility
Midas Care Manager/ UR
Epic ED
Midas Care Manager/ UR
Epic ED
Epic Clinical Documentation
Epic Clinical Documentation
ePremis Claims Processing
Third Millenium Claims Digital Archive
3M Coding
ePremis Claims Processing
3M Coding
Third Millenium Claims Digital Archive
Powerscribe
Epic eMAR
Epic eMAR
Epic E-Signature
Epic E-Signature
Powerscribe
WinPFS
WinPFS
Epic Patient Tracking
Epic Patient Billing
Epic Patient Tracking
Epic Patient Billing
QuadraMed- WinPFS Patient Acuity
FINANCIAL SYSTEMS
FINANCIAL SYSTEMS
ANCILLARY SYSTEMS
ANCILLARY SYSTEMS
Lawson Accounts Payable
Lawson General Ledger
Kaufman Hall Budgeting/ Financial Planning
Kaufman Hall Budgeting/ Financial Planning
Lawson General Ledger
Lawson Accounts Payable
Epic Rx
HBS Outpatient Rx- Retail POS
NDC Outpatient Rx- Retail POS
Epic Rx
Sunquest Lab
Sunquest Lab
Lawson Human Resources
Workbrain Time Attendance
Kronos Time Attendance
Lawson Payroll
Lawson Human Resources
Pyxis Medication Distribution
McKesson CVIS
MedSelect Medication Distribution
Radiant Radiology
Lawson Payroll
Radiant Radiology
Emegeon CVIS
Siemens Cardiology
Lawson Payroll
ImageCast Radiology
Peopleclick (Recruitment)
TractManager Contracts Management
TractManager Contracts Management
Ascent Contract Management
Peopleclick (Recruitment)
Epic Home Health/ Hospice
Stryker Surgery Center Systems
Computrition Nutrition Services
VST Nutrition Services
SurgiServ Surgery Center Systems
Epic Home Health/ Hospice
Ascent Contract Management
Decision Support
Lawson Materials Management
Management Reporting
Lawson Materials Management
Management Reporting
CoPath Pathology
GE QS Labor Delivery
Epic OR
CoPath Pathology
Epic OR
Decision Support
GE QS Labor Delivery
Epic/ Varian
Hospira Smart Pumps
Provation GI Lab Documentation System
Hospira Smart Pumps
MISCELLANEOUS SYSTEMS
MISCELLANEOUS SYSTEMS
Oncology
Ansos Scheduling- Clinical
Various Scheduling- Non-Clinical
Ansos Scheduling- Clinical
Kronos Scheduling- Non-Clinical
Kodak PACS
McKesson PACS
Pyxis OR Surgical Supply Station
Hologic Digital Mammography
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And a few more
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Metadata Friend or Foe?

• Provide A Description By
• Category
• Location
• Of All Relevant
• Electronically Stored Information

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Intentional Design The Missing Ingredient?

• Technologists
• GIGO
• Replication Or Innovation?
• Risk Managers On Design Team?

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Results of Lack of Intentional Design?
Version Control or Not?
Portability or Not?
Transparency or Not?
Access Controls or Not?
Audit Trails or Not?
Archiving or Not?
Print Management or Not?
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Is Risk Embedded in Project Oversight?
Governance
Direction
Delivery
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Living with an EMR

• Training -- never ends
• Implementation -- never ends
• Build, Implement, Optimize, Repeat
• Some things are hard!
• Users should never worry about hardware, system
  stability or access to downtime data
• CQI at its best Its really all about workflow
  and efficiency and Process Improvement

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And as we enter budget season
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Commiseration Contact s

• Laird A. Pisto Paul VanAmerongen
• Associate General Counsel Manager, Information
  Security
• MultiCare Health System MultiCare Health System
• PO Box 5299 PO Box 5299
• Mail Stop 222J-1-LEG Mail Stop 124-2-IS
• Tacoma, WA 98415-0299 Tacoma, WA 98415-0299
• 253-403-1186 253-459-7482
• Laird.Pisto_at_multicare.org Paul.VanAmerongen_at_multic
  are.org